health care

House Democrats Push Tepid Mental Health Policy Bill to Compete With Popular Republican-Led Efforts

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Daniel Case/Flickr

Apparently May is "Mental Health Awareness" month, so let's get aware of what politicians are planning in terms of mental health care policy. Both congressional Democrats and Republicans are pushing mental health care bills right now. But while the Republican-led legislation has drawn widespread support, the Democrats' version, introduced by Rep. Ron Barber (D-Ariz.) this week, is getting a much less enthusiastic response. Many have slammed the bill—which Rep. Nancy Pelosi (D-Calif.) is said to have had a large hand in crafting—as a "stripped down, politically orchestrated" version of the measure Republican Rep. Tim Murphy, a clinical psychologist from Pennsylvania, introduced in December 2013.

Murphy's multifaceted bill, called the "Helping Families in Mental Health Crisis Act" (H.R. 3717), has the support of the American Psychological Association, the American Psychiatric Association, the National Alliance on Mental Illness, and many other medical groups. The Washington Post editorial board also supports Murphy's measure, writing in an April 16 editorial that it was "more comprehensive than other recent efforts to reform the system and perhaps has the brightest prospects in a divided Congress." Of the bill's 77 co-sponsors, one third are Democrats. 

"The bill would reorganize the billions the federal government pours into mental health services, prioritizing initiatives backed by solid evidence and tracking their success," explained the Post. It would do so by creating an assistant secretary of mental health and substance abuse disorders to control mental health funding, thereby shifting power away from the Substance Abuse and Mental Health Services Administration (SAMHSA), which currently administers state mental health grants.

Murphy's measure would also change Medicaid to allow psychiatric hospitals to be reimbursed for short-term stays. It would make it easier for families of mentally ill patients, particularly younger patients, to obtain medical info from doctors and records. And it pushes states to adopt policies allowing judges to compel severely mentally-ill people into involuntary treatment. 

This last bit has been the most controversial. Critics of Murphy's bill have focused on the way it expands the control that families and the state have over the treatment of severely mentally-ill individuals. They also say the bill ignores community treatment programs aimed at reaching people with mental disorders before things get out of control.

"We do not see those aims as mutually exclusive, and neither do the bill's backers," the Post's editorial board wrote. One might also point out that current-style efforts to reach people before it's too late haven't been so hot. 

But the Democrats' bill, called "The Strengthening Mental Health in Our Communities Act," is largely focused on such efforts. It would increase mental health funding for various groups (schools, veterans, community organizations). It would also reauthorize the SAMHSA, create a White House Office for Mental Health Policy to run it, and require Medicare to cover longer hospital stays for mental health care hospitalizations.

"It has more candy for the mental health industry than Murphy's bill and stripped out all the programs that help those with the most serious mental illnesses," said DJ Jaffe, executive director for the New York-based Mental Illness Policy Organization. 

In a Wall Street Journal op-ed, Kim Strassel called the Democrats introduction of the competing bill "the basest form of politics." Strassel suggested the measure is not just a ploy to kill Murphy's bill, but also to prop up the idea of gun control as the one true solution to serious mental illness. Mental health advocates told USA Today they're simply worried that the new bill will shift enough support away from Murphy's bill that neither will get anywhere. 

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  1. to prop up the idea of gun control as the one true solution to serious mental illness

    Er, what?

    1. See, if the mentally ill can’t get guns, there will be no more mass shootings.

      1. Except police continuing to shoot/kill massive amounts of crazy people.

      2. And since you often can’t tell that someone is mentally ill until after they do something, the safe thing to do is not allow anyone to have guns.

  2. But proggies and Nancy care! So what if their actual efforts hurt, rather than help.

    /derp

  3. Acceptable alt-text: “Cracker Factory”.

    1. I always liked “Puzzle Factory”

  4. “And it pushes states to adopt policies allowing judges to compel severely mentally-ill people into involuntary treatment.”

    I expect it to be about as hard to get a judge to compel mentally-ill people into involuntary treatment as it is to get a search warrant. …and how hard is that?

    Oh, and, you know, in some states, judges are elected.

    I worked in a full lock-down mental hospital for a couple of years, and involuntary commitment to such a place would be my worst nightmare. I’d rather go to prison.

    And there’s already criteria in place to lock crazy people up–it’s if they’re a danger to themselves or others. They can typically hold you for 72 hours if you’re considered a danger to yourself or others, and during that 72-hours, they evaluate you further.

    After 72-hours, a judge (or a judge’s representative) comes by and evaluates the hospital’s claim to keep you–if that’s what they want to do–and that system works pretty well.

  5. There are two things to watch out for here: 1) You’d be surprised how often whether a hospital wants to keep you is a function of whether you have good insurance. High deductible? He’s fine! Get him outta here! 2) Local governments will want to use this as a means to get homeless people off the street.

    If they’re not a danger to themselves or others, there’s no excuse to keep crazy people locked up. Sorry if respecting crazy people’s individual rights is inconvenient and an eyesore, but doing so is kinda the difference between right and wrong. Deal with it.

    Crazy people don’t owe us anything except respect for our rights. Guess what? We owe them the same thing, too.

    1. I agree and Jacob Sullum explained it beautifully here, in an online debate organized by the CATO institute: http://www.cato-unbound.org/20…..commitment

  6. And it pushes states to adopt policies allowing judges to compel severely mentally-ill people into involuntary treatment.

    Terrible reform.

    1. Why? It would only be used for people who are a danger to themselves or others. Or Racists and Homophobes. Or Climate Deniers. Or,…

      1. Realistically, like Ken said above, it would be used exclusively to remove homeless people that annoy the wrong control freaks.

      2. look on the bright side: shreek!

  7. Question for those of you in the know about this subject. Before Carter let the soon-to-be-homeless people out of the various facilities around the country, were those people involuntarily committed? Or were they there voluntarily and the rest of us were just paying for it? And how would this new law be different from the arrangement 40 years ago?

    1. Good question = I don’t know

      From what I read, there’s a bit of myth surrounding the Carter/Reagan transition. Carter’s main ‘reform’ law was rescinded one year after it was passed; however, there was a major move from Federally funded Mental Health treatment to State Funding.

      http://en.wikipedia.org/wiki/C…..nalization

      ” In 1980…Congress passed the Mental Health Systems Act, which provided federal funding for… community mental health programs.[5] This Act strengthened the connection between federal, state, and local governments with regards to funding; ../just a year after the Mental Health Systems Act was passed, the Omnibus Budget Reconciliation Act of 1981 was passed. The Omnibus Act was passed by the efforts of the Reagan administration as an effort to reduce domestic spending. The Act rescinded a large amount of the legislation just passed…the legislation that was not rescinded was almost entirely revamped”

      The ‘deinstitutionalization’ trend is blamed on both Liberals and Conservatives = the emergence of new drugs were seen as a way to reduce costs and improve quality of life.

      I’m not sure there was a significant change in the “involuntary” standards, which AFAIK has always been ‘if person presents a danger to themselves or others, and has approval of a family member’. If there was any change, it was in ‘how long’ they’d keep someone before dumping them back on the street.

  8. “May is “Mental Health Awareness” month, so let’s get aware of what politicians are planning in terms of … policy”

    I’ve had a severely mentally ill family member (my brother) for the last ~17 years. During that time I’ve seen a wide variety of dimensions of the ‘mental healthcare system’. It is something very few people outside the system ever see (or want to see). It is that way for a reason.

    The very first doctor who ever looked @ my bro after his ‘break’ made a comment to me….

    “The system is just an updated Asylum = inpatient, outpatient – the goal is to make patients “less visible” to the public. Whether its physical or chemical, ‘treatment’ is mostly about making “the sick people” tolerable to the sane: not actually ‘helping them’ or fixing their problems. Why? because we can’t. Despite all the advances in antipsychotics and other psychotropics, its mostly so much ‘masking’ or ‘minimizing’. There’s basically zero research into other kinds of treatment. The main reason is “Crazy People Don’t ‘Heal'”. Even worse, they don’t DIE from their illness (most of the time). They require treatment forever. This makes them the most expensive patients in the world, with the least likelihood of any ‘success’. Consequently, the entire medical profession has pretty much sidelined Mental Health and said, “The best we can do is keep them quiet”. That’s the reality you are going to have to deal with. Get used to it.”

  9. The short take-away from my point above =

    I expect nothing but optics from any ‘new policy’. Its stuff to bash the other party with. Perhaps some money will be ‘moved around’. New bureaucrats will be hired. Perhaps some asshole will propose “Registration”! Dems will want to throw money at schools, Repubs will want to help Law Enforcemnent. Blah blah blah.

    I can not emphasize to you enough the depth of cynicism needed to fully appreciate “Mental Health Care” in America. They will blow 10billion just talking about this shit and not a dime will ever go anywhere near actual ‘treatment’. Why? its *untreatable* as far as most in the system are concerned. The money is all about changing how it is viewed by the ‘sane’ public. That’s it. Optics.

  10. Very disappointing piece by Reason Magazine. I would write a detailed critique to explain why lowering the standard for civil commitment (in fact having civil commitment at all) is a very bad idea, however I will not.

    Instead, I will let Reason Magazine Senior editor Jacob Sullum explain why: http://www.cato-unbound.org/20…..commitment .

    The notion that civil rights can be abused as long as some psychiatrist says so is a betrayal to every single principle embraced by Reason Magazine and its libertarian audience.

    Reason Magazine should have no doubt that the Murphy bill is a travesty and it should ask its readers to actively oppose it.

    1. Do you have the reading comprehension of a gnat? Nowhere did the writer endorse lower standards of voluntary commitment.

      1. Actually, it is more you being totally ignorant about what the real difference between the two bills is.

        This piece is clearly sympathetic to the Murphy bill. The only substantive difference between the two bills is the issue of civil rights: Tim Murphy’s expands involuntary drugging and involuntary commitment. It also weakens HIPAA protections that keeps your toxic family members at bay. The latter point is even a concern of unashamed defenders of psychiatry http://psychiatrist-blog.blogs…..tions.html .

        The Tim Murphy bill is the democratic bill plus a whole lot of provisions that make abuses of civil rights for so called “mental health reasons” easier.

        It is a shame that nether the writer of
        this article not you see that.

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